Any suggestions on why I keep hitting capillaries lately?

Since the end of August I’ve been hitting capillaries all the time.

This used to happen to me every few months… sometimes I would notice blood in the cannula, and bad times the blood would fill up the tubing as soon as I inserted.

In last August one night I inserted 3 Dexcom G4 sensors in a row… each of them resulting in a gusher.

Then is started happening with my Medtronic Mio sets as well, here is the most recent one (on the left is one that I noticed at 2:30am after inserting it at 11pm the night before) and the older bruise to the right was from last week):

I call Medtronic and Dexcom customer service each time it happens, and they all tell me that “it happens, you’re just unlucky” but I used to only run into this every couple months… not every couple set changes!

My endo had the same answer:

“What seems to be happening is that since you don’t have much subcutaneous tissue then it’s easier to hit the capillaries. Unfortunately there is no way to predict if you are going to hit a capillary or not.”

Any suggestions?

i very often experience the exact same problem. i am super lean and have very little sub q fat on my body. i wear a MM pump and a dexcom sensor. i get the gushers too. one thing someone on TuD suggested to me has helped a great deal: stretch out your skin slightly under a bright light/lamp with your fingers and try and see the areas where you have the bluish capillaries, and then be as certain as possible to avoid them. also, i have found that when i am trying to insert a new infusion site and the introducer needle hurts against my skin tenderly, i move on to another location. (many times that first stick will bleed a bit afterwards, so i am glad i did not bother to insert there.) unfortunately, sometimes , after a day or so w/ my MM pump site, i will see a bit of blood around the canula. i realize i am not getting the best insulin absorption either. so i take it out and re-do it. it is a pain in the a** , but take it out anyway and start over. ( this will also help you not to create scar tissue in that area)

as far as the sensor placement goes, it is more of a challenge b/c the sensor placement area is larger. i do continue from time to time to get the gushers, but it is rarer than it used to be. basically, i have had to leave the abdomen area completely with my sensor placement and move on to other, “fattier” areas, like my hips, thighs, butt, arm…i just don’t seem to be able to have any success whatsoever with my abdomen area.

i hope that some of this helps you even a little. i know it can be extremely frustrating, but have as much patience as you can. you’ll get the hang of it.

Aren’t the Dexcom sensor insertion needles quite long (relative to their competition), AND angled? I can’t tolerate angled anything (sets or sensors). Ergo, I use the Enlites.

Thank you for the suggestions, Daisy_Mae.
I’ll try looking for the capillaries (you’re not looking for the big blue veins, right?)

phoenixbound, yes… the G4 has an angled inserter.
I’ve been using the Mio infusion sets for the past 4 years (the only pump I’ve had) but Medtronic keeps suggesting that I try the Silhouettes specifically because they are angled but I don’t see how that would help me since if it’s a capillary issue, it’s still going to hit it. 6mm Mio cannula or 13mm angled won’t change much.

The last Medtronic rep suggested trying the Sure-T Infusion Set, but that terrifies me.
I’ve been Type 1.5 for 5 years and was a total needlephobe before then… The Mio and G4 inserter make my needle phobia a lot less of an issue than when I used to do MDI 5 years ago.

Thanks again for the help everyone, I used to be a regular on the older tudiabetes site… but moved across the country to a new job and haven’t had a chance to visit!

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I certainly can empathize with you on the needlephobia. Even enclosed in the inserter, I find the Dexcom sensors quite scary, despite the experience that they barely ever hurt much, if at all!. For infusion sets, I use insets - thosde needles are visible, so even scarier, but the inserter helps a bit. Been lucky on the capillary issue, at least - only had one Dexcom sensor bleed (the very FIRST one!) and 2-3 infusion sets (in a year on a pump).

no, bort269, i am not talking about the veins, just the tiny capillaries beneath the first layer of your skin. you have to look for them under bright light, but they are there. thats most likely what you’ve been hitting. and even though they are small they pack a mean and nasty punch for spurting blood. also, i am on the MM silhouette, but my canulla/introducer needle are both straight. i have very little problem sliding them under the skin on an angle…maybe a 45 degree angle in order to get it just under the skin, so i don’t hit any nerves or muscle. I use the Silhouette Paradigm 23inch tubing (i like the short length so i don’t get all tangled up in it) w/ the 17 mm canula. which pump do you use? mine is the MM Paradigm and i have grown rather fond of it. good luck. hope this was somewhat helpful.

I have a Paradigm as well (tudiabetes used to have a Profile page which showed my devices and recent A1C levels, but I can’t seem to find it! :slight_smile:

Maybe I’ll be brave and try out the Silhouette (Medtronic actually sent me a sample with a 13mm canula), the inserter just looks a bit scarier than the Mio (which is closer to the G4 inserter, since you don’t see the needle). I can’t believe how long the inserter needle stays in your body: https://www.youtube.com/watch?v=kb8d0A0VFfg (unlike the Mio where you can pull the needle out immediately)

Thanks again, Daisy_Mae!

Thas, my G4 insertions hurt about one-third of the time… but at least when they do (unless it’s a gusher) it doesn’t seem to affect my sensors, they all seem to last at least 2 weeks lately.

I’m serious when I say I’d rather have someone start an IV on me, than install a Silhouette. I tried several of them. Not going down that road again! :slight_smile:

you’re not helping, phoenixbound! :stuck_out_tongue:

My entire life, I was only ever scared of 2 things: spiders and needles. I’ve held cobras while extracting their venom, been on the fastest and scariest rollercoasters on Earth (even proposed on one!), gone skydiving… etc. but it was only just spiders and needles that ever got me.

I’ve gotten better with the spiders ever since I became a father (5 years ago, same year that my Type 1.5 showed up) since I don’t want my daughter being arachnophobic, but even though I get blood draws every 3 months now (and test 10 times a day) needles are still tricky for me!

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I had blood drawn 20+ times the first year OI was Dx’d with T2D - and nearly pass out every time! Doesn’t seem to get easier. Somehow I managed MDI and both the Dex and pump – but I hesitate every time!

Have you tried using other sites that have more Sub Q tissue like the Outer Thigh, or upper buttocks? That might help. Give your abdomen a rest, looks like you got some serious bruising there…Just a thought.

I use the Contact Detach, similar to the Sure-T. Yes, you can see the needle, no, there is no inserter. However, they are so comfortable, and I am very lean but have never hit anything bloody. Also, you can pick your spot since you push the needle in yourself. If I touch the needle to my skin with a tiny bit of pressure, and it hurts, I don’t put it in that spot.

Having been on MDI for 26 years prior to pumping, I have a phobia of inserters! I need to be 100% in control of the needle. The Dexcom inserters still freak me out, even though it never really hurts that bad.

i am on board w/ you 100%. i use the MM Paradgm and use the 13mm straight introducer needles. not only do i touch the potential area of insertion to see how sensitive it is w/ the tip of the needle, (and sometimes there is even a little blood that comes out on that spot) i move on to another location. i love being in control of the process. i also use the dexcom cgm and can get a bit freaked out by the inserter/plunger. i can’t see whats going on under there. obviously if it hurts going in, i remove it right away (and i call dex tech support and report it immediately. they replace bum sensors for free.)

My Dexcom insertions hurt ~50% of the time (I’m always amazed when I barely feel it, those are great days :slight_smile: I’ve been inserting G4 sensors for 4 years and—unless it’s a gusher—the sensors always work fine… and the pain usually goes away after a couple days.
A couple times I’ve had it hit a nerve ending, where there is no pain… but a random movement (usually when in bed) will cause a painful electric-like shock.

I’ve never thought of touching potential sites with a needle (since I’ve always used inserters)… I always just poke around with my finger, but maybe I should use my lancet device to test out a site!

Maybe indeed it’s time to start exploring more sub-Q tissue (like my outer thigh, or upper buttocks)
I’ve only ever used my abdomen and rarely: my love handles (where there is space for ~one infusion set) because I really don’t have much real estate to work with.

My lack of body fat is no excuse or explanation for this, though, since there are many type 1 kids with even less real estate than me… and they don’t run into this issue.

Thanks for your advice, everyone!

Have you been paying attention to where and when you’ve been putting the sites in? Maybe at a certain time of day people’s capillaries are more dilated, or I’m assuming if you do it right after a shower, in a hot or humid room, et.c. the capillaries would be more dilated and therefore easier to hit?

I don’t know, I’m probably totally wrong, but it was a thought.

Good question, MissMargie, as time is a parameter I haven’t changed much lately:
I change my sites every 3 days in the evenings (except when I found blood in the cannula at 2:30am one morning)

I was curious if I should try using an ice pack before inserting, but the Medtronic reps had no advice about that.

I´ve had a hard time finding sites that work myself, and I´ve found that poking around with a needle until I find a spot that´s 100% painless is a great way to find painless sites that works great. You avoid bot nerves and blood vessels this way.

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I recently submitted this blog post about my site rotation. Sometimes overuse of a spot or area causes the bleeding. Maybe, this can help.

What happens to your blood sugar when you hit a cappilary? I know when my set is in blood. My bs goes high and corrections don’t bring it down. They say after 2 corrections if your blood sugar doesn’t go down suspect your site.

I think you are actually hitting veins. Capillaries don’t really bleed like that. For me I can feel a vein under the skin after years of doing it.
When I was on injections I can touch the needle to my skin and feel weather or not I’m on a vein.
A vein hurts a lot more even just the skin above it.
If you take your needle and touch several spots you will start realizing when you are in a good spot.

I still use this method when inserting my infusion sets. I just do that every 3 days.
It has been a very long time since I’ve hit one.

Years ago they would teach you to draw back the syringe to test for veins, but now they don’t.